Hacker News Reader

Comment by ryanmercer | Hacker News Reader

>As a South Korean citizen it is jarring that other countries including the US and Japan isn't really trying to test people.

It's apparently quite expensive here. Federal minimum wage is $7.25 an hour, while one reported cost [0] for the test is:

>$3,270 two weeks after his test. He will be responsible for $1,400 of that bill.

That's almost 10% of my annual gross before insurance and I have almost 14 years at my job. For someone working a minimum wage job that's more than 11 week's gross income. I imagine they are limiting the number of tests on people that could have any number of other things and waiting for symptoms to strongly point towards the virus due to the simple fact that the tests cost so much. If a patient can't pay, whatever hospital has to carry that cost for potentially years before the patient can repay them (or not get paid at all if it pushes someone to bankruptcy).

Until the government sets aside money to subsidize the tests, I imagine the testing rates will remain low.

[0] https://www.independent.co.uk/news/world/americas/coronaviru...

View on HN

Looks like we can add healthcare reform to the list of potential geopolitical consequences to this virus. Time to see if the U.S. medical establishment is really as dire as many claim online.

If what you're saying is true about prices, there really will be a full blown outbreak if people can't afford to be tested. I presume some sort of emergency order will be given Nationwide to make testing available for free.

> Looks like we can add healthcare reform to the list of potential geopolitical consequences to this virus.

Only if someone takes action, which will likely only happen with public outcry, which will also only likely happen if a whole lot of people die or at least a few celebrities. I'd wager money against it.

> Only if someone takes action, which will likely only happen with public outcry, which will also only likely happen if a whole lot of people die or at least a few celebrities.

I think your ultimate conclusion is far too cynical and pessimistic.

The popularity of universal healthcare just in the last 15 years has gone from "herpes" to "acceptable as long as it is a business-driven solution that doesn't rock the boat too much" to "you're disqualified from running for the Democratic nomination for the presidency if this isn't at the heart of your campaign". It polls extremely well on a bipartisan basis, and why shouldn't it? Insurance companies are almost unanimously loathed.

Seventy+ percent popularity for healthcare reform plus the possibility of a national crisis that could stretch our systems to the breaking point, damage the economy, and cause individual spending? This could be the push that finally brings a national health system to the US.

I thoroughly agree.

At this point, people around the world are getting testing, treatment, and hospitalization that costs little or nothing. In the US, the health secretary is strongly implying that people will have to pay for vaccines and care.

I have to expect that Americans will wonder how it can be that the world's richest country, a superpower, with supposedly the best health care in the world, is also the only country in which people go bankrupt just trying to stay alive during a pandemic.

Hmm, I’m not really familiar with US’s medical system... so some questions:

* Does that mean someone who gets minimum wage (which probably doesn’t have an additional health insurance except for a default one) needs to pay for $1400 to test? (If true, that’s insane - why does the government only take cares of $1700 and not something like $3000?)

* Does people who come from Wuhan/other places where COVID-19 is spreading (lets say an american that comes from Daegu - the district with the most patients in Korea) also have to pay the high price to be tested?

The US medical system is a complete disaster. Basically, the government doesn't pay for anything; only private insurers do. And they try to avoid paying for as much as they can get away with. On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.

"Basically, the government doesn't pay for anything; only private insurers do."

That's not true. Poor people can get Medicaid, old people can get Medicare, and there are also various other ways of getting one's health care expenses subsidized by the government if you're poor or have medical reasons for not being able to work.

Just to be clear:

I'm for 100% state-funded medical care, but it's simply not true that "the government doesn't pay for anything; only private insurers do". The government does pay for quite a lot, even if many people in the US don't qualify for such aid.

They absolutely should qualify for such aid, in my view, but my opinion doesn't change anything. Some people qualify, some don't, and the government does pay for some, and private insurance does not pay for absolutely everything in the US. These are just facts.

If you're poor and you live in the South (and certain other states), you can NOT get Medicaid. Unfortunately this decision was left up to each state.

And even in states where you might be eligible, it's not going to help you (or the public) if you haven't enrolled.

Tricare for active and retired military and their families. Whatever the Federal government does for health care which I assume is some kind of government-managed insurance pool. Not sure how state, county, and city workers are covered (might be through private plans, might vary state to state).

Lots and lots of people already have "government healthcare". Just not enough.

You're focused on the trees, not the forest. The prior commenter is right: Unless you are very poor (and get Medicaid) or old (and get Medicare), most Americans receive no government assistance for healthcare.

The US is a disaster. Even if everyone in the country caught the virus, and 2% of the population died from it as a result, we'd still be in the same exact situation because there's a majority of people who believe that reality is biased and that some people need to suffer. There would be a huge part of the population who would see the lack of government response (due to a lack of funding and leadership) as a fundamental reason for why we should reduce the role of government influence in these situations.

That's just false. The US federal government spends over $1,000,000,000,000 on healthcare per year. Only Social Security is a bigger expenditure. It's almost twice what it spends on the military. It's 8.5% of its humongous GDP. That's a larger percentage than most European countries. Germany's the only country I'm aware of where the government spends substantially more of the country's GDP on healthcare than the US.

It should be noted, however, for spending a much larger percentage of GDP they are still only providing coverage to about 1/5 of the population while most other countries you're discussing are covering 100% of the population.

It should also be noted that they are covering the age group with the most medical issues. The other age groups have lower healthcare costs.

> Basically, the government doesn't pay for anything; only private insurers do.

The US government spends about the same on healthcare as many other governments, which makes the terrible standard of care even more confusing.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

> Basically, the government doesn't pay for anything; only private insurers do

The US government does spend huge sums of money on healthcare.

Medicare and Medicaid are 21% and 16%, respectively, of total healthcare spending as of 2018. [0]

That's 37% of the total.

Given that total healthcare spending is about $11,172 per capita, that's $4,133.64 per capita. [0]

The UK spent £2,989 per person in 2017 in total. [1]

It's not correct to do so, but using today's GBP to USD exchange rate that's roughly $3850.

This puts US per capita government spending alone (keep in mind it's Federal + state) in the same ballpark as the UK's entire healthcare expenditure per capita.

> On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.

Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).

[0] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

> Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).

Has anyone estimated the impact of costly lawsuits->higher professional insurance costs->higher prices->higher medical insurance prices vicious cycle ?

That's a huge talking point among the right, yes.

Yes, but it's mostly not a huge issue in terms of overall costs. Many states already cap med-mal liabilities.

Currently, Virginia is capped at $2.4 million. https://law.lis.virginia.gov/vacode/title8.01/chapter21.1/se...

Sounds like a lot on first glance, but if you're young and lose a lifetime of income, or need a lifetime of assistance/follow-on care, due to negligence, it's a drop in the bucket.

> Specifically, physician salaries plus diagnostic tests comprise 4.04% of GDP in the US, compared to only 2.3% in the UK.

https://www.sciencedirect.com/science/article/pii/S001429212...

If you read more, I believe diagnostic testing comes out to 0.5% of GDP in the UK vs. 2% of GDP in the US, a far bigger effect than the difference in salaries.

So yes, there is some indication that lawsuits can lead to more tests and thus wildly higher testing costs.

I wonder if this is also leading to doctors to favoring newer medications that should be "the best" versus cheaper generics that would be more cost effective for a particular ailment.

Speaking of which, the way drug approvals and patents work also increases costs, and there are perhaps some small tweaks like permitting foreign first-world drug approvals to count in the US as well that might also help keep a lid on costs.

That is the rational for ‘tort reform’, to make these numbers more predictable.

>>The US government does spend huge sums of money on healthcare. >Medicare and Medicaid are 21% and 16%

Ok, I misspoke there, but the US government does not spend anything on you if you don't qualify for one of these two programs.

Most minimum wage workers also don't have health insurance ( at least in my hometown area ), and that means they'd be in the hook for the entire amount.

> Most minimum wage workers also don't have health insurance

Oh, I thought that the government provides a default one; realized that US doesn’t have a ‘default’ insurance from the sibling comment.

> that means they'd be in the hook for the entire amount.

Thats... insane and sad.

From what I understand, under the so-called "Obamacare" legislation, everyone in the US has to have insurance, and if they can't afford it then it'll be subsidized to some extent by the government. You do have to be poor enough to qualify for such subsidies, though.

"Poor enough" means you make less than ~$50,000 for a single person though. (Twice that for a family of four.) That puts you in the top 20% in the US and would be the top 10% in most of Europe.

It's up to 400% of the FPL and that only gets you a "credit", you're still liable for the premiums up to about 10% of your income. Plus any other "features" like deductibles, copays and coinsurance.

The requirement to have insurance has been dropped.

In the grand tradition of USA politics, that responsibility has almost entirely been abdicated to the states.

Some states took federal funding to expand Medicaid and make it available to anyone making 138% of the federal poverty line -- think around $35k annually for a family of four.

Others did not. Consider Texas: medicaid is available for children, pregnant women, adults caring for children, and a few other special groups (children transitioning out of foster care, certain disabilities, etc.) It is not something that is available for all Texans.

In Texas, a single parent caring for one child would have to make less than $103 per month to receive coverage.

https://yourtexasbenefits.hhsc.texas.gov/programs/health/you...

> If true, that’s insane - why does the government only take cares of $1700 and not something like $3000?)

Because a government that does healthcare is socialism that that's considered inherently evil by many.

And you're right: the healthcare system is absolutely insane.

If you can afford it (like I do), it's obviously world class in its medical abilities, but it's a disaster in terms of administrative overhead and its inability to serve the general population.

The funny thing is that a government doing healthcare is not socialism at all. It's just good stewardship over something that is too much of a temptation for the capitalists to handle properly because 'life is priceless'.

>not socialism at all. It's just good stewardship over something that is too much of a temptation for the capitalists to handle properly

That's what socialism is.

>needs to pay for $1400 to test?

The individual in that article likely had reasonably good insurance, someone earning minimum wage likely would have insurance that would cover very little if anything and they'd likely owe the entire 3* amount.

The countries doing lots of testing are basically countries with socialized medicine, the cost is being passed on to the tax payers. For the United States you are responsible for your medical costs, if you are fortunate you have good insurance that will cover varying percentages of your medical insurance.

I have 'good' insurance, several years ago I required hospitalization and ended up incurring somewhere between 13 and 15k USD in bills for about 30 hours in the hospital and the ambulance ride. I ended up paying something like 12-13% of that. At a start I personally owed 100 USD for every single doctor that touched my case which ended up being 5 doctors if I recall correctly, only 3 of which I ever met. In this instance the hospital was very courteous and allowed me to set up a payment plan and repay them, interest free, over many months. I paid the debt off over a year and a half if I recall correctly.

They then wanted more blood over the next several days and had to see a primary care physician to get my medical leave paperwork filled out and those two things cost me another 200-300 USD after insurance.

> The individual in that article likely had reasonably good insurance, someone earning minimum wage likely would have insurance that would cover very little if anything and they'd likely owe the entire 3* amount.

That’s worser than I thought :-( I was thinking that $1400 is too pricey to anybody — turns out that it was higher for people who don’t have insurance.

> For the United States you are responsible for your medical costs

Is this a culture/mind difference, or does everybody in the US doesn’t like this but has no time to fix it? Genuinely interested, as most people in our country almost everybody relies on only the default insurance — is this a cultural difference between the US(western world) and here? Are countries in the Europe similar?

>Is this a culture/mind difference, or does everybody in the US doesn’t like this but has no time to fix it?

This is just the way it is. We don't know anything else and when you start talking about changing it a lot of people lash out and can get quite heated.

Our government is not the best at managing things efficiently, socialized medicine means it gets paid via taxes, the medical and drug companies have lobbyists and can largely get away with setting whatever prices they want right now, etc.

Personally I'd be fairly hesitant to get on board with socialized medicine here in the United States purely for the fact I would fear it would be just as corrupt and I don't know if the increased taxes would be more than I pay for my insurance currently considering my employer pays more of the cost of my insurance than I do and I doubt that sudden savings would be passed on to me as increased pay.

One of our two parties is actively working to get rid of even the existing insurance programs for the poor (Medicaid) and elderly/disabled (Medicare). The people who support them would rather their fellow Americans die than to help them. This is the culture here. The other party is just now starting to think about providing people with insurance. It doesn't matter that there is huge support among the people to have proper insurance as you do and every other developed country in the world does. That's why things are the way they are. On the other hand though, we have just lowered business taxes and have no problem spending money on the military and other garbage while people suffer and die from lack of healthcare. Greatest country in the world.

> That’s worser than I thought :-( I was thinking that $1400 is too pricey to anybody — turns out that it was higher for people who don’t have insurance.

He's giving you false information, that's not actually true.

If you are poor you don't usually have a deductible in your insurance (because it's government subsidized), which means you are responsible for LESS of the bill, not more.

People have a lot of false views on US healthcare, mainly because it's a political issue, so people have a strong motivation to spin it one way or another.

America is suffering from political decay that makes public administration very difficult.

Poor public administration makes people lose trust in government, which contributes to political debate.

This is a vicious cycle.

As applied to healthcare, many Americans, including leftists, simply aren’t confident the government can achieve major public programs.

Obamacare is a good example: it has been slowly gutted. How? By litigating it again and again at different levels and forums of government.

After congress passed the law, states had to agree to go along, courts federal courts had to sign off, stage courts had to sign off, etc.

There’s no way to enact major changes in American society anymore.

So most Americans, very logically and rationally, favor small incremental changes over big programs.

The healthcare system in the US is a shameful mess, but for someone that makes minimum wage they'll likely be on Medicaid, which is one of the US government's health programs. It's complicated, but likely in that case a person getting a blood test won't have to pay anywhere near the $3000 or $1700 amount. It'd probably be free, but I say probably because it's possible that your blood test gets sent to a lab that isn't Medicaid approved and who pays for it gets complicated at that point.

In the example case given from the article, that person likely made too much money to qualify for Medicaid, so they probably have a bad health insurance plan that has a high deductible. Which is why they're getting stuck with a huge bill for something that really shouldn't cost anywhere near $3000.

Anyone that pretends that the way the US health care system functions right now is good is either lying or an idiot.

Edit: As another person pointed out, to complicate things even more every state has a different implementation of Medicaid. If you're in one of those states that believes your poverty is your own fault, you probably have no health coverage at all.

> in that case a person getting a blood test won't have to pay anywhere near the $3000 or $1700 amount. It'd probably be free

Oh, that’s much, much more assuring to know. Looks like

> Anyone that pretends that the way the US health care system functions right now is good is either lying or an idiot.

Looks like the general consensus of HN agrees; I hope the US decides to overhaul the healthcare system to provide better care if everything I’m hearing in this thread is true, it’s a topic that’s saddening to hear about.

Someone making the federal minimum wage working full time makes $15,080 a year. For an individual to be eligible for Medicaid, they have to make (for 2019) less than $17236.20 a year (138% * Federal Policy Level $12,490). So yes, in states that don't have a higher minimum wage, they would just barely be covered, but millions of people making minimum wage in states that have raised the minimum wage or making just above minimum wage are not covered by Medicaid. In such a case, it's better to make less money by working less rather than lose that insurance because Medicaid is great insurance while what is available at such jobs is likely garbage.

And of course, there are the asshole states that did not expand Medicaid coverage. In those states, people making such little money are fucked. The ACA may help with discounts but I doubt any reasonable insurance can be had. Hell, I can't find decent insurance through the ACA in my state and I'm willing to pay anything. Super fucked up. I totally agree that people who defend this system are assholes or idiots. No other way around it.

Yup, this is super important to note too. You could make minimum wage in your state -- and likely live in a state with an overall higher cost of living -- but still not qualify for Medicaid because the low wages you make aren't low enough. It's awful.

Basically these kinds of bills push 9 out of 10 people into bankruptcy.

So part of the reason you're paying $3000 for a test that actually costs $300 is because you're paying for 9 other people who couldn't pay.

All the sibling comments touch on valid points. I'm going to try and summarize them for clarity.

- The US has a few nationalized (single-payer) insurance programs... TriCare for military, Medicare for retirees, and Medicaid for the indigent. - Obtaining Medicaid is not easy - you have to be truly indigent in many states (it's federally funded, but states manage their own programs) - Everybody else is left to buy their own insurance policy. Sometimes this is partially funded by an employer, but not always. - Due to the high cost of insurance (and health care in general), many plans have very high copays and deductibles.

So, even with an average health instance policy, a person could be stuck with the full cost of that test because of a deductible. In the past, I've had deductibles as high as $5000/individual, $12,000/family (note: I don't know, we're back on a PPO with a $2000 deductible).

When I use a medical service, I usually receive a statement that lists retail prices for services rendered, negotiated fees (between MD and insurance), and sometimes an excess amount that I owe.

If the hospital is "out of network" (no contract between insurance and hospital), I could be due a larger chunk of the bill personally (up to 100%, depending on insurance plan). This is called "balance billing" - google will give you all sorts of insane results from $50,000 helicopter rides to entire hospital centers that don't work with a single insurance provider so they can bill whatever they want.

As noted elsewhere, it's a complete mess and embarrassment for one of the wealthiest nations on the planet.

That's crazy. But what I think is: considering that's an epidemic that is dangerous and quickly spreading, shouldn't the government just decide to test people coming from places with a lot of cases already? And pay for it?

A couple years ago the current administration fired the entire pandemic response team and did not replace them. Just the other day he claimed this entire situation was no big deal and would fizzle out on its own. Assuming the administration would do anything that helps anyone is a poor assumption

Oh, it's crazier than you can imagine.

We have a healthcare system that demands my wife goes into the doctors office when fully healthy during the midst of flu season with an unknown epidemic ongoing just to get a refill for the same maintenance meds she's been on for over 30 years. Simply because they haven't billed us anything for over 6 months.

These policies actively spread infection and expose a larger number of the population to infected people.

It gets worse. Many service workers in the US do not have sick leave or insurance. If you work in a restaurant, you can legally be fired without notice for taking off a shift to go to the doctor. Then, several states have virtually no tenant protection laws, so the landlord can start legal eviction proceedings just a few days after missing a single payment.

Awesome, so basically if someone suspects they are infected, they won't get tested because they can't pay, and they still need to go work at the restaurant, infecting everyone else.

That's so reassuring!

Just wait until a walmart produce worker thinks it is a cold and decided that they cant afford the time off and comes to work and spreads it to thousands of people.

I am more worried about the warehouse worker that is loading the food into the trucks for Walmart, Kroger, and Amazon.

What's crazy about this is that, by "saving money" on asking people to pay for their tests, people won't get tested, spreading it more, causing more deaths and cases. Which I think is more expensive than the tests...

Medicaid covers poor people and children, and is the largest single way people are covered in the entire U.S. It is managed by each state, with some federal subsidies.

Someone who makes the minimum wage, working full time, will make ~$22,000 per year, and that is above the income limit in my state. Therefore they will not qualify for state Medicaid. They will have to pay out of pocket for this test, whatever their private for-profit health care plan does not pay. And whether they get their own health care plan, or the employer pays some of it through an employer provided health care plan, depends on how many employees the company has. And in fact it's no longer compulsory that individuals even have a health care plan, the individual mandate no longer exists. And there is no such thing as an option to buy into a public plan, either Medicaid or Medicare (people over 65).

If this person worked part time instead, they'd actually be in a better position in terms of health care, where Medicaid would pretty much cover the cost of this test.

> Medicaid covers poor people

Only in states that expanded Medicaid under the ACA. The entire South and much of the mid-West didn't expand Medicaid.

The government does not take care of anything. Almost all health insurance for working age adults is private - provided either by their employer or bought on a government run exchange. Among those private insurances, usually the insurance pays around 1/2 and the worker pays half. So you are stuck with a $1700 if you get tested.

Also minimum wage in the Us ranges from $7 to about $15 in very expensive areas. So depending on you let salary you are left with 2 choices

1. Get tested if you have a severe flu or cold like symptoms and not eat and pay rent for a few weeks.

2. Tough it out , wait a few days/weeks and hope it goes away.

It’s what the persons health insurance company would be charged.

Except it wouldn’t.

It’s really more of a starting point for the negotiations between the insurance company and the hospital.

What’s paid at the end is anyone’s guess.

And that assumes you only need the one test.

And that was a flu test, not a coronavirus test.

Reply on news.ycombinator.com